Matenda a mliriwu, omwe anthu adagonjetsa zaka zoposa 1,500 zapitazo, poyamba adayambitsa kuphulika kwakukulu kwa matenda, kutenga makumi makumi ndi miyanda ya miyoyo ya anthu. Mbiri siidziwa matenda ena opanda chifundo komanso opweteka, ndipo mpaka pano, ngakhale kuti chitukuko cha mankhwala chinapangidwa, sizinali zotheka kuthetsa vutoli.
Kodi mliri ndi chiyani?
Mliri ndi matenda mwa anthu, omwe ali a chilengedwe cha matenda opatsirana, nthawi zambiri zimathera pamapeto. Ichi ndi matenda opatsirana kwambiri, ndipo chidziwitso chake ndi chilengedwe chonse. Pambuyo pa mliri wodulidwa ndi kuchiritsidwa, chitetezo chokhazikika sichingapangidwe, ndiko kuti, pali chiopsezo chotenga kachilombo ka HIV (koma kachiwiri matendawa ndi ovuta).
Chiyambi chenicheni cha dzina la matendawa sichikhazikitsidwa, pamene mawu akuti "mliri" omasulira kuchokera ku Turkish amatanthauza "kuzungulira, cone," kuchokera ku Chigiriki - "shaft", kuchokera ku Latin - "kugunda, kuvulaza". M'mayambiriro akale ndi amakono a sayansi, munthu akhoza kupeza tanthauzo lotere monga matenda a mliri wa bubonic. Ichi ndi chifukwa chakuti chimodzi mwa zizindikiro zosiyanitsa za matendawa ndi bubo - kutupa kozungulira kumalo a lymph node yotentha. Pankhaniyi, pali mitundu ina ya matenda, popanda mapangidwe a buboes.
Mliri ndi causative agent
Kwa nthawi yaitali sikunadziwone chomwe chimayambitsa mliri wa bubonic, causative agent anadziwika ndi kugwirizana ndi matenda pokha kumapeto kwa zaka za m'ma 1900. Iwo anakhala bakiteriya a gram-hasi kuchokera m'banja la enterobacteria - chikhomo (Yersinia pestis). Tizilombo toyambitsa matenda timaphunzira bwino, ma subspecies angapo amavumbulutsidwa ndipo zotsatirazi zikukhazikitsidwa:
- akhoza kukhala ndi mawonekedwe osiyana - kuchokera ku filiform mpaka pamphepete;
- Kusungika kwa nthawi yaitali kwa anthu odwala osiyana;
- zabwino toler tolerability kutentha, kuzizira;
- kutetezeka kwambiri kwa mankhwala ophera tizilombo toyambitsa matenda, kuwala kwa dzuwa, asidi zomwe zimachitika chilengedwe, kutentha;
- lili ndi makina makumi atatu a antigenic, amavomereza kutha- ndi zowonongeka.
Mliri - njira zolowera mabakiteriya kulowa m'thupi la munthu
Ndikofunika kudziwa momwe mliliwu umatulutsira kuchokera kwa munthu ndi munthu, komanso kuchokera kwa zamoyo zina. Plagiarum imayenda m'magulu amtundu wathanzi mwazilombo zakutchire, zomwe zimaphatikizapo makoswe am'mlengalenga, nthaka yamphongo, imphuno, nkhono zakuda, makoswe a nyumba, amphaka, lagiformes, ngamila. Odwala (tizilombo toyambitsa matenda) ndi tizilombo toyambitsa matenda a mitundu yosiyana siyana komanso mitundu yambiri ya tizilombo toyambitsa magazi omwe ali ndi kachilombo koyambitsa matendawa pakudya nyama zodwala zomwe zili ndi mliri m'magazi.
Kusiyanitsa kufalitsa kwa tizilombo toyambitsa matenda kudzera mu utitiri kuchokera kwa zonyamulira nyama kwa anthu ndi munthu ndi munthu. Tilembera njira zowonjezera mliri kulowa m'thupi la munthu:
- Kusamalidwa - kulowa m'magazi mutatha kulumidwa ndi tizilombo toyambitsa matenda.
- Kuyankhulana - poyang'anizana ndi munthu amene ali ndi khungu kapena mazira a microtrauma, ndi matupi a zirombo (mwachitsanzo, pamene akudula mitembo, kukonza matumba).
- Zowononga - kudzera mu mucosa wa tsamba la m'mimba pamene mukudya nyama ya odwala omwe sanaperekere mankhwala okwanira, kapena mankhwala ena.
- Kuyankhulana ndi azimayi - kumakhudza munthu wodwala, kulankhulana ndi zakumwa zake, kugwiritsa ntchito mbale, zinthu zaukhondo ndi zina zotero.
- Pulogalamu ya piritsi imachokera kwa munthu ndi munthu kudzera m'magulu a kupuma pamene akukhathamiritsa, akudula, kukambirana kwambiri.
Mliri - zizindikiro mwa anthu
Kuchokera pa malo oyamba a tizilombo toyambitsa matenda kumatengera mtundu womwewo wa matendawo udzakula, ndi kuwonongeka kwa ziwalo zomwe, ndi mawonetseredwe ati. Mitundu yotsatira ya mliri wa munthu imayima:
- chiwonetsero;
- pulmonary;
- septic;
- m'mimba.
Kuwonjezera pamenepo, pali mitundu yochepa ya matenda monga khungu, pharyngeal, meningeal, asymptomatic, avortive. Matenda a mliri ali ndi nthawi ya masiku atatu mpaka 6, nthawi zina 1-2 masiku (ali ndi mapepala apamwamba kapena mawonekedwe a septic) kapena masiku 7-9 (mu katemera kapena odwala kale). Mitundu yonse imadziwika ndi chiwombankhanga chodzidzimutsa ndi zizindikiro zoopsa komanso matenda oledzeretsa, zomwe zikuwonetsa izi:
- kutentha kwa thupi;
- chills;
- mutu;
- ululu wa musculo-articular;
- chisokonezo;
- kusanza;
- kufooka kwakukulu.
Pamene matendawa akukula, maonekedwe a wodwala amasintha: nkhope imakhala yonyada, maonekedwe, ma whitcha maso amawoneka ofiira, milomo ndi lilime zimakhala zouma, mdima wamdima umakhala pansi pa maso, nkhope imasonyeza mantha, mantha ("chigoba cha mliri"). M'tsogolomu, wodwalayo akusowa nzeru, kulankhula sikungatheke, kugwirizana kwa kayendetsedwe ka zinthu kumasokonezeka, kupusitsidwa ndi ziwonetsero zimaonekera. Kuonjezerapo, zilonda zapadera zimakhala, malingana ndi mawonekedwe a mliri.
Mliri wa Bubonic - zizindikiro
Ziwerengero zimasonyeza kuti mliri wa bulonic ndi mtundu wodwala kwambiri wa matenda umene umayamba ndi 80% mwa iwo omwe ali ndi kachilombo koyambitsa tizilombo toyambitsa tizilombo kudzera mu mazira ndi khungu. Pachifukwa ichi, matendawa amafalikira kupyolera mu mitsempha ya mitsempha yowopsa, yomwe imayambitsa ziwalo zamagulu za inguinal, nthawi zambiri - mchenga kapena chiberekero. Zomwe zimayambitsa zimakhala zosakwatiwa ndi zingapo, kukula kwake kumatha kusiyana ndi masentimita 3 mpaka 10, ndipo mu chitukuko chawo nthawi zambiri amadutsa muzigawo zingapo:
- kuwonjezeka, kuumitsa ndi kupweteka kwa maselo am'thupi - masiku angapo pambuyo poyambitsa matenda oledzeretsa (mu chithunzi cha bubonic pa wodwala ndi buboes)
- kuchepetsa bubo - tsiku 4 la matenda;
- kusokonezeka kwadzidzidzi, kupanga chilonda kapena chigawo cha necrosis - pa tsiku la 10 la mliriwu.
Mliri wamakono
Fomu iyi imapezeka mu 5-10% mwa odwala, omwe ali ndi nthendayi yomwe imayambitsa matenda a chiwindi (primary) kapena kuti chiwerengero cha mtundu wa bulonic (wachiwiri). Izi ndi mitundu yoopsa kwambiri, komanso zizindikiro zenizeni za mliri mwa anthu mu nkhaniyi zikupezeka pafupifupi pa tsiku 2-3, mutayamba kumwa mowa kwambiri. Wothandizira mankhwalawa amakhudza makoma a alveoli yamapuloni, omwe amachititsa zinthu zoopsa. Zisonyezero zosiyana ndi izi:
- Kupuma mofulumira, kupuma pang'ono;
- chifuwa;
- Kutuluka kwa mliri - poyamba kofiira, poyera, ndiye - ndi mitsempha ya magazi;
- ululu m'chifuwa;
- tachycardia;
- kusiya kuthamanga kwa magazi.
Mtundu wa Septic wa mliri
Mliri waukulu wa septic womwe umayamba pamene mliri waukulu wa tizilombo toyambitsa matenda umalowa m'magazi, siwowamba, koma ndi kovuta kwambiri. Zizindikiro zosokoneza zimawoneka mphezi mofulumira, monga tizilombo toyambitsa matenda amafalikira ku ziwalo zonse. Pali ziphuphu zambiri m'makhungu ndi mucous tissue, conjunctiva, m'mimba komanso m'magazi, kutuluka mofulumira kwa mantha oopsa opatsirana . Nthaŵi zina mawonekedwewa amapitirira ngati chidziwitso chachiwiri cha mliri wina, umene umawonetseredwa ndi kupanga mapepala apamwamba.
Mimba ya m'mimba ya mliriwu
Osati akatswiri onse amasiyanitsa matumbo osiyanasiyana a mliriwo mosiyana, kuwachitira ngati umodzi mwa mawonetseredwe a mawonekedwe a septic. Pamene matumbo a m'mimba amaonetsa zizindikiro za matendawa mwa anthu omwe sakhala ndi chizolowezi choledzeretsa ndi malungo, zotsatirazi ndizo:
- ululu wamimba;
- kusanza kwamagazi ambiri;
- kutsekula m'mimba ndi masenje a mucocutaneous;
- Kufuna kupweteka matumbo.
Mliri - Kudziwa
Ntchito yofunika kwambiri yodziŵika ndi "matenda" a ma laboratory diagnostic, yomwe ili ndi njira zotsatirazi:
- chipembedzo;
- chithandizo;
- zochepa kwambiri.
Phunziroli likutenga magazi, phokoso kuchokera ku buboes, zilonda zosiyana, zofiira, zogawanika, masanzi. Kuti muone ngati pali mankhwala osakanikirana, zakusankhidwa zimatha kukhala wamkulu pamasewera apadera. Kuphatikiza apo, X-ray ya zam'mimba ndi mapapo amapangidwa. Ndikofunikira kukhazikitsa chenicheni cha tizilombo, kulumikizana ndi nyama zodwala kapena anthu, pitani kuzungulira zolimbana ndi mliriwu.
Mliri - mankhwala
Ngati matenda akugwidwa kapena akupezeka, wodwalayo amachiritsidwa mofulumira m'chipatala cholandira chithandizo m'bwalo lokhalokha, komwe kutulukamo kutuluka kwa mpweya. Chithandizo cha mliri mwa anthu chimachokera pazochitika izi:
- kulandira mankhwala opha tizilombo toyambitsa matenda, malinga ndi mawonekedwe a matenda ( Levomycetin , Tetracycline, Streptomycin);
- detoxication therapy (Albumin, Reopoliglyukin, Gemodez);
- kugwiritsa ntchito mankhwala kuti zipangitse kupanga microcirculation ndi kukonza (Trental, Solcoseryl , Pikamilon);
- mankhwala ophera antipyretic ndi achizindikiro;
- mankhwala othandizira (mavitamini, mankhwala a mtima);
- plasmapheresis - ndi septic lesion.
Pa nthawi ya malungo wodwala ayenera kumvera mpumulo wa bedi. Thandizo la antibiotic likuchitika masiku asanu ndi awiri ndi asanu ndi asanu ndi awiri (7-14), ndipo pambuyo pake maphunziro opangidwa ndi zinthu zowonongeka amapatsidwa. Wodwala amamasulidwa atatha kuchira, monga umboni wopezera zotsatira zitatu zolakwika. Kupambana kwa chithandizo kumadalira makamaka pa nthawi yeniyeni yowunika mliri.
Njira zothetsera mliri mu thupi la munthu
Pofuna kupewa kufalikira kwa matenda, njira zothandizira zosafunika kwenikweni, kuphatikizapo:
- Kusanthula chidziwitso chokhudza mliri wa mliri m'mayiko osiyanasiyana;
- kudziwika, kudzipatula ndi kuchiza anthu omwe akudziwika kuti ali ndi matenda;
- Kutsekereza kwazomwe zimayenda kuchokera kumadera osagwirizana ndi mliriwu.
Kuonjezera apo, ntchito nthawi zonse imagwiritsidwa ntchito mwachilengedwe cha matendawa: kulingalira chiwerengero cha makoswe zakutchire, kufufuzira iwo kuti azindikire mabakiteriya a mliri, kuwononga anthu omwe ali ndi kachilombo, kumenyana ndi utitiri. Pozindikiritsa ngakhale wodwala mmodzi m'mudzi wokhazikika, zotsutsana ndi mliri zikuchitika:
- Kuyika kwaokhaokha ndi kuletsa kulowa ndi kutuluka kwa anthu masiku angapo;
- kudzipatula kwa anthu omwe anali ndi odwala ndi matenda;
- matenda opatsirana pogonana.
Anthu omwe adakumana ndi mliri wodwalayo, pofuna kuteteza, amatumizidwa kuti athetsa mliri wa mliri pamodzi ndi mankhwala opha tizilombo. Katemera wotsutsana ndi mliri kwa katemera wa mliri wa munthu wodwala matenda a mliri umayikidwa pazochitika zoterezi:
- pamene ali ndi matenda a chilengedwe kapena kutuluka kumene kumalo osayenera;
- kuntchito, yogwirizana ndi kuthekera kwa magwero a matenda;
- pamene pali kufalikira kwakukulu kwa matenda pakati pa zinyama pafupi ndi midzi.
Nthendayi - ziwerengero zofooka
Chifukwa cha chitukuko cha mankhwala ndi kusamalira njira zothandizira, matenda a nthendayi sagwira ntchito zambiri. Kalekale, pamene palibe mankhwala omwe anapangidwira matendawa, imfa inali pafupifupi zana limodzi. Tsopano chiwerengerochi sichiposa 5-10%. Pa nthawi yomweyi, ndi anthu angati amene adafa ndi mliri m'dzikoli posachedwapa, sangathe kudandaula.
Mliri m'mbiri ya anthu
Mliriwu m'mbiri ya anthu unasiya njira zoopsa. Chifwamba kwambiri ndizo miliri izi:
- "Chigwa cha Justinian" (551-580 gg.), Chimene chinayambira ku Igupto, kumene anthu oposa 100 miliyoni anafa;
- Mliri wa "imfa wakuda" (XIV) ku Ulaya, unatsika ku East China, womwe unapha anthu pafupifupi 40 miliyoni;
- mliri ku Russia (1654-1655 gg.) - pafupifupi anthu zikwi 700 kufa;
- mliri ku Marseilles (1720-1722) - anthu zikwi zana anamwalira;
- Mliri wa mliri (kutha kwa zaka za m'ma 1900) ku Asia - anthu opitirira mamiliyoni asanu anafa.
Mliri masiku athu ano
Mliri wa Bubonic masiku ano umapezeka m'mayiko onse, kupatula ku Australia ndi Antarctica. Kuyambira chaka cha 2010 kufikira chaka cha 2015, matenda opitirira 3,000 a matendawa anapezeka, ndipo zotsatira zake zowopsya zinapezeka mu 584 odwala. Ambiri amalembedwa ku Madagascar (oposa 2,000). Nkhanza za mliri zapezeka m'mayiko monga Bolivia, USA, Peru, Kyrgyzstan, Kazakhstan, Russia ndi ena. Malo oopsa a mliri wa Russia ndi awa: Altai, Kumidzi Yoyera, Stavropol, Transbaikalia, Lowerland Caspian.